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CURRENT LOCATION INFORMATION (including city, state,ZIP) <br /> Current location:2445 Pacific Blvd SW,Albany, OR 97321 County:Linn <br /> ❑ Dealer lot Dealer name: Dealer license number: <br /> ❑Park name(if applicable): <br /> Out-of-state/federal or tribal property location: <br /> IF BEING MOVED, LOCATION CHANGES (including city, state, ZIP) <br /> New location:1139 Chemawa Loop NE, Keizer, OR 97303 County:Marion <br /> ❑Dealer lot Dealer name: Dealer license number: <br /> Q Park name(if applicable):Rainbow Gardens Mobile Village <br /> Out-of-state/federal or tribal property location: <br /> OWNER <br /> Current owner names: <br /> Are you changing the name of an existing owner? ❑Yes 0 No <br /> Changing from: to: <br /> Home transfer by inheritance? (1 Yes I No If yes,attach appropriate Inheritance Affidavit(Form 2946 or 5177) <br /> Home transfer due to foreclosure? ❑ Yes C No If yes,attach Affidavit of Repossession(Form 3926) <br /> Home transfer through abandonment process? ❑Yes ❑Q No If yes,attach Abandonment Affidavit(Form 2951) <br /> If yes,attach Change Affidavit <br /> Home transfer through divorce,trust,or right of survivorship? ❑Yes I No (Form 5221) <br /> BUYER/NEW OWNER INFORMATION(one name per box) <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Evans, Barbara, I <br /> Mailing address: Mailing address: <br /> 1139 Chemawa Loop NE <br /> 1 Keizer, OR 97303 2 <br /> Phone number: Phone number: <br /> 971-915-2998 <br /> Email address: Email address: <br /> barbievans2@icloud.com <br /> Buyer/new owner name (Last,first, middle): Buyer/new owner name (Last,first, middle): <br /> Mailing address: Mailing address: <br /> 3 4 <br /> ❑ Same as above ❑ Same as above <br /> Phone number: Phone number: <br /> Email address: Email address: <br /> 440-2952(7/17/COM) Page 3 <br />